Member Application

Please note: Renewal is for current members only. If your membership has lapsed, you must join as a new registration.

My profile information
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is the same as last year needs to be updated

Name
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First Name Last Name

E-mail
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Preferred Phone Number
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-
Area Code Phone Number

Phone Type

Cell Work Home

Alternate Phone Number

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Area Code Phone Number

Phone Type

Cell Work Home

Second Family Member
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First Name Last Name

Second Family Member E-mail

I would like an additional login to the USSPWDC website for my family member.

Second Family Member Cell Phone

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Area Code Phone Number

Address
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Street Address

Street Address Line 2

City

State

Zip Code

Country

New Puppy Information

We are excited to welcome new puppies and their owners to the USSPWDC. Come join us and explore the wonderful world of PWD activities.

Our new puppy owner members must not have been members of USSPWD Club previously, and the breeder of the puppy must be a Club member. Dues will be waived for the remainder of the current membership year.

Welcome Aboard !!

Call Name
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Age (in months)
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Gender
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Breeder Name
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First Name Last Name

Please provide the date you obtained your puppy.
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Month
-
Day Year

Date

Portuguese Water Dogs Currently Owned

Call Name

Age

months years

Gender

Call Name

Age

months years

Gender

Call Name

Age

months years

Gender

Call Name

Age

months years

Gender

Call Name

Age

months years

Gender

Call Name

Age

months years

Gender

What club activities would you like to see this year?

Interested in Volunteering?

Other Dog Clubs

Are you a member of the PWDCA?
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Yes No

List any other dog clubs that you maintain a membership in

Club Membership Definitions

Individual Membership:Annual Dues $25.00. An Individual member has one eligible vote in club elections.

Family Membership:Annual Dues $35.00. A Family membership is any number of people living in the same household. There will be two voting members per family.

New Puppy Membership:New puppy members when approved, will have a complimentary membership for the balance of their first year. A Puppy Membership has no voting rights.

Hold Harmless AgreementIn signing this application I hold harmless the USSPWD Club and its Board of Directors, members and the owners of the premises on which activities are held, from any claim of loss or injury which may be alleged to have been caused directly or indirectly to me or to my dog(s) while involved in any club activities. I personally assume all responsibility and liability, and I enter the said premises, for whatever purpose, at my own risk.

Constitution and Bylaws I (we) agree to abide by the Constitution and Bylaws and Rules of both the Portuguese Water Dog Club of America (if a member) and the American Kennel Club. I (we) also agree to abide by the Constitution and By-Laws of the United Sunshine States Portuguese Water Dog Club, a copy of which is available upon written request.

Do not include my information in the official USSPWDC roster.

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I certify that the information supplied in this application is complete and correct.